$400 million in long-awaited opioid settlement money will begin to go out to Colorado communities by late summer

The first dollars of a years-long, multi-state legal settlement designed to punish pain pill manufacturers and distributors for their role in the nation’s lethal opioid addiction scourge will start flowing into hard-hit Colorado communities before summer’s end.

The $400 million allocated to Colorado from the $26 billion nationwide settlement inked last year with AmerisourceBergen, Cardinal Health, McKesson and Johnson & Johnson — along with proceeds from a previous settlement with Purdue Pharma — is meant to help slow the state’s surging overdose crisis.

Colorado Attorney General Phil Weiser said the money should start reaching communities far and wide starting in August and September.

“We have seen 25 years of tragedy — with pills, heroin, fentanyl — that is killing more and more people,”  Weiser said in an interview with The Denver Post. “We have now held accountable some of the worst offenders who have caused this crisis. This is the start of a new chapter to save lives and address this painful crisis.”

Colorado saw 1,258 opioid deaths last year, compared to 956 in 2020, according to data from the Colorado Department of Public Health and Environment. Of those opioid deaths last year, 912 involved fentanyl — up from 540 in 2020.

As recently as five years ago, there were fewer than 100 fentanyl overdose deaths in Colorado.

Those on the ground in the fight against opioid addiction said people shouldn’t be fooled into thinking the settlement money — which will be spread over the next 18 years — will prove a quick remedy to a problem that has tentacles sunk deep into society’s larger mental health challenges.

“This money will help save lives,” said Dr. Robert Valuck, director of the Colorado Consortium for Prescription Drug Abuse Prevention at the University of Colorado Anschutz Medical Campus. “But don’t be under the illusion we just solved this problem.”

Valuck compares the settlement to adding a single tool to the myriad ways of fighting a wildfire.

“It’s another way of dumping water on the fire,” he said. “But it’s a big-ass fire.”

Rural addiction challenges

For many Colorado communities, especially those far removed from the ready resources and treatment facilities of the Front Range, any weapon to combat a drug like fentanyl — a synthetic opioid that can quickly hook and harm people — is welcome.

That includes Mesa County, where last month the U.S. Attorney’s Office for Colorado announced that a pair of Grand Junction men had been indicted in separate cases on federal charges of distributing fentanyl resulting in death. Just a few weeks earlier, a Grand Junction man charged with smuggling fentanyl from Mexico pleaded guilty to distribution resulting in death.

Illicit fentanyl is created in laboratories, most commonly in Mexico and China, and smuggled or shipped into the U.S. as pills, powder or mixed into other drugs. It’s cheaper to make than cocaine and heroin, and easier to obtain than diverted prescription painkillers like oxycodone.

It’s also extremely potent — the Drug Enforcement Agency estimates fentanyl is 50 times as powerful as heroin and as little as 3 milligrams can be lethal.

“Fentanyl is really hitting us hard,” Mesa County Commissioner Janet Rowland said. “While (the money) may not solve all of our problems, it will be a piece of the solution.”

More than half the $400 million coming to Colorado will be distributed through 19 “regions” that account for all 64 of the state’s counties. Some are single-county regions — metro Denver’s populous counties are set up this way — while more sparsely populated parts of the state are grouped into regions made up of multiple counties.

Twenty percent of the money will go directly to local governments, 10% to the state and the final 10% to an “infrastructure fund,” which Weiser said will benefit less affluent parts of the state where there may not be treatment or recovery centers nearby.

“This infrastructure fund is available to the San Luis Valleys of the world,” he said, referring to a vast stretch of southern Colorado where towns are small and distances between them are great.

Weiser said the money will be tracked through his office and a public-facing dashboard showing how it’s being used will be added to the attorney general’s website in the coming weeks. Governments can only use the funds for opioid abatement purposes, such as drug treatment, recovery, prevention and education, as well as harm reduction programs.

“You can’t do something unrelated to the opioid crisis, like building new baseball fields,” Weiser said.

The regional bodies must first submit an assessment plan to Weiser’s office, outlining how they want to spend the money assigned to them. Rowland said Mesa County, which is its own region and is due to receive nearly $400,000 a year from the settlement, has submitted its two-year spending plan to the state.

It focuses half of its expenditures on recovery from drug use, 33% on treatment and the rest on prevention and education.

Mesa County, according to its plan, hopes to decrease the number of young people “interested in or already using substances” while also boosting the number of health care professionals in the county who are qualified to treat people with substance abuse disorders.

Specifically, the county identified $150,000 for a “youth mentoring/truancy diversion program,” nearly $300,000 for treatment and services aimed at those transitioning from prison or homelessness, and $400,000 for a “recovery community organization” that tracks and manages clients.

“If we can intervene when they show signs of truancy at school, we might be able to stop this trajectory of their life,” Rowland said of halting the habit before it forms. “We want to make sure that the money is spent in a way that it works.”

A seven-hour drive across the state from Grand Junction gets you to Prowers County, one of nine southeast Colorado counties that make up Region 19 in the state’s opioid abatement landscape. There, Commissioner Wendy Buxton-Andrade said, the challenge is getting qualified caregivers to work in such a remote part of the state.

“We have always had trouble growing our own counselors,” she said. “It’s kind of hard for us to compete with metro area for pay.”

Yet, opioid addiction has been an acute issue in this part of Colorado for years. The problem was big enough that Huerfano County, also a part of Region 19, became the first Colorado government to sue the nation’s top pharmaceutical companies and distributors four years ago, claiming that its residents were falsely induced to take highly addictive opioids for pain management.

Its lawsuit claimed the opioid epidemic was caused by drug makers engaging in fraudulent and deceptive marketing and by distributors who brought large amounts of medication into the marketplace.

“In a lot of these rural areas, we had a lot of prescriptions going out the door,” Buxton-Andrade said.

Poison is “killing people”

And the opioid problem today is far more troubling than it was when the crisis began in the 1990s — or even compared to a decade ago, said Cath Adams, a recovery coach in the Roaring Fork Valley who founded the El Jebel-based organization Aperture of Hope.

“It’s not like it was 10 years ago when people got addicted to their pain meds,” she said. “Fentanyl is a poison that is killing people.”

Adams lost her daughter two years ago when the 21-year-old took a Percocet pill that she didn’t know was laced with fentanyl.

Hers is one of an increasing number of cases where Coloradans are dying after unwittingly ingesting the drug. Five friends died in a Commerce City apartment in February, taking what they thought was cocaine. A month later, a teenager fatally overdosed at her desk in a Colorado Springs high school after taking a pill she thought was Percocet.

The legislature this session passed HB22-1326, which was signed into law by Gov. Jared Polis in May, to stiffen penalties for fentanyl possession. Before the law was enacted, possessing less than four grams of a wide range of drugs, including fentanyl, was considered a misdemeanor.

The new state law makes it a felony to possess at least one gram of fentanyl or fentanyl compound. The bill also directs money toward harm-reduction tools, including testing strips and lifesaving opioid antagonists such as Narcan. It expands drug addiction treatment in jails.

It’s those harm-reduction strategies, rather than incarceration, that many recovery specialists say are most crucial now as overdose numbers climb year after year. Lisa Smith, a family recovery coach who founded and runs Reclaim and Recover in Colorado Springs, said medication-assisted treatment for those with opioid dependency is the “gold standard.”

According to the Substance Abuse and Mental Health Services Administration, medication-assisted treatment uses drugs, along with counseling and behavioral therapies, to provide a holistic approach to treating substance use disorders. Prescribed drugs, including buprenorphine, methadone and naltrexone, “normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative and euphoric effects of the substance used,” according to the agency.

Naloxone, otherwise known as Narcan, can stop an overdose in progress. Smith said naloxone should be stocked in every school, given the insidious infiltration of fentanyl in the overall drug market.